Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 09/2009; 468(1):102-7. DOI: 10.1007/s11999-009-1112-3
Source: PubMed


Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCL-retaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and -substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear.

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Available from: Adrija Sharma, Apr 01, 2014
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    • "There was no instability in any patients in this study at the last follow-up. Proper alignment and soft-tissue balance is essential to the stability, wear, and long-term outcomes of TKA, especially in younger patients with higher activity level262728. The majority of patients had excellent KSS, and 68% were participating in recreational activities on a regular basis at minimum 11 years. "
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    ABSTRACT: Abstract Background The aim of this study was to evaluate long-term quality and performance of cemented posterior-stabilized (PS) total knee arthroplasty (TKA) in young and active patients with gap balancing technique. Methods Between January 2000 and October 2001, 55 TKAs (21 rotating platform [RP] and 34 fixed bearing [FB]) in 41 patients, 60 years and younger, with University of California Los Angeles (UCLA) activity score of five and above were included in this study and prospectively followed. Clinical assessments included Western Ontario and McMaster Universities (WOMAC), Knee Society, UCLA activity score, and Patient Administered Questionnaire (PAQ). Radiographic measurements included component positioning, patellar tilt and thickness, radiolucency, loosening or osteolysis. Results At a mean follow-up of 12.3 ± 0.5 years (11 to 13), there was no instability, malalignment, or patellofemoral maltracking. Sixty eight percent of patients were still participating in regular recreational activities at the final follow-up. The mean satisfaction score was 9.1 ± 1.9 and 8.5 ± 2.1 in RP-PS and FB-PS groups, respectively. There was no malalignment or osteolysis, no revision for osteolysis or loosening. One patient in the FB-PS group underwent open reduction and internal fixation for a peri-prosthetic fracture. Overall Kaplan–Meier survivorship was 98%. Conclusion The PS TKA in young and active patients can provide long-term durability and high quality of function. Level of evidence III
    Full-text · Article · Jan 2016 · The Knee
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    • "Boldt et al. (2006) showed that this technique results in 90% of femoral components being placed within ± 3° in relation to sTEA, while Luyckx et al. (2012) reported similar femoral component rotation achieved by measured resection and gap balancing . Some authors have hypothesized that gap balancing provides better functional performance following primary TKA than TKAs performed using measured resection (Dennis et al. 2010, Daines and Dennis 2014). "
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    ABSTRACT: Background Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival. Methods We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered. Results Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain. Interpretation Based on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA.
    Full-text · Article · Jul 2014 · Acta Orthopaedica
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    • "Dennis et al.15) compared the stability of 40 measured resection TKAs and 20 gap balanced TKAs. The presence and magnitude of femoral condylar lift-off was evaluated for each technique at 0, 30, 60, and 90 degrees of flexion using an automated 3-dimensional model fitting kinematic analysis. "
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    ABSTRACT: A goal of total knee arthroplasty is to obtain symmetric and balanced flexion and extension gaps. Controversy exists regarding the best surgical technique to utilize to obtain gap balance. Some favor the use of a measured resection technique in which bone landmarks, such as the transepicondylar, the anterior-posterior, or the posterior condylar axes are used to determine proper femoral component rotation and subsequent gap balance. Others favor a gap balancing technique in which the femoral component is positioned parallel to the resected proximal tibia with each collateral ligament equally tensioned to obtain a rectangular flexion gap. Two scientific studies have been performed comparing the two surgical techniques. The first utilized computer navigation and demonstrated a balanced and rectangular flexion gap was obtained much more frequently with use of a gap balanced technique. The second utilized in vivo video fluoroscopy and demonstrated a much high incidence of femoral condylar lift-off (instability) when a measured resection technique was used. In summary, the authors believe gap balancing techniques provide superior gap balance and function following total knee arthroplasty.
    Full-text · Article · Mar 2014 · Clinics in orthopedic surgery
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